“So what happened, man?” I ask the guy as I shine a penlight into his eyes, checking his pupillary responses.

“Got hit,” mumbles the guy, stating the obvious. With one hand, he’s holding the absorbent gauze pad I’ve given him against the big laceration on the side of his head, as he absentmindedly tugs his shorts up with the other. Not too far up, mind you – just enough to perch precariously on his ass cheeks and still leave about four inches of boxers showing. Scalp wound and abrasions be damned, he has street fashion to consider.

“I meant, what happened exactly,” I explain patiently, suppressing the urge to roll my eyes. I palpate the back of his neck. “What did they hit you with, and did you get knocked out?”

“Hell no!” he blurts indignantly, pulling away. He starts getting wound up, because now he has a story to tell. He gestures animatedly to the porch behind him, and to his buddies currently being interviewed by the police. There is a small crowd gathered on the street. “See, I was just sittin‘ here, kickin‘ it with my peeps, noamsayne? Mindin‘ my own, noamsayne? And then…”

…And you were just sitting there with your Bible study group, drinking a wholesome glass of milk and holding your weekly devotional, when all of a sudden and for no reason…

“…and then, I just got jumped, noamsayne? And I di’int do nuthin!“

No doubt there were seven of them, far too many for you and your homies to defeat in a stand-up, fair fight.

“Then, dude just drops the brick and runs off!”

Whoa, just one guy! He must have been a baaaaaaaad ass…

“Did you get a look at this guy?” I ask. “Would you recognize him again?” Immediately, his eyes turn shifty and evasive.

“Nah man, I ain’t ever seen dude before,” he lies. “He just some dude.”

“Sumdood?” I ask with sharpened interest. “You say Sumdood jumped you?”

He’s close, I can feel it. I knew it when the hairs stood up on the back of my neck when I got out of the rig. Evil lurks nearby.

“Yeah man,” the guy confirms. “Some dude.”

“There he is, over there!” the guy’s girlfriend says helpfully, pointing toward the crowd, “just standin‘ over there like he ain’t did nuthin‘!”

“Shhh, don’t point at him!” I hiss, pulling her arm down. “Just be cool, a’ight?”

“Aww girl, that ain’t him,” the guy says, feigning disgust. “Siddown and shut yo mouf.”

“That is him!” she insists. “I seen tha‘ whole thang!”

“Shut. Yo. Mouf. Woman!” the guy warns through clenched teeth. The girlfriend, chastened, clams up.

He recognizes the guy, he just doesn’t want to admit to it. He’ll round up his posse and try to exact some street justice as soon as all the cops have gone. But he doesn’t know who he’s dealing with. All of them together are no match for Sumdood.

I catch Farting Partner’s eye and jerk my head toward one of the cops. He nods in understanding, hands me the two-inch tape he’s holding, and saunters over to one of the currently unoccupied police officers. Attempting to look casual, I finish taping up the gauze helmet FP has applied to our patient’s lacerated cranium.

“What’s up?” Officer Friendly asks quizzically as FP steers him over to us.

“Don’t look too obvious,” I tell him sotto voce, “But the perpetrator is standing over in the crowd. It’s Sumdood.”

Officer Friendly’s eyes narrow, and he casts a surreptitious glance at the crowd. “Which one?” he asks, rolling the toothpick to the other side of his mouth.

“The guy in the wifebeater shirt, baggy black denim shorts, with all the bling.”

“And which one of twenty would that be?” Officer Friendly asks, mildly exasperated.

“Sorry,” I apologize. “The one second from the left, toward the back. About five-ten, 160 pounds, corn row braids. It’s Sumdood, I know it.” The girlfriend nods in confirmation.

“Him?” Officer Friendly asks incredulously. “Sheeeeeit, that’s just Tyrone. He’s a low level crack dealer. I’ve busted him a couple of times. He’s harmless.”

“I don’t care what his street name is, I’m telling you it’s Sumdood!” I insist. “The victim identified him!”

“He doesn’t fit Sumdood’s description,” the cop informs me. “I’ve got a composite sketch of him in the cruiser. Sumdood is at least six-three, and weighs 235. And he has an Afro. Besides, they just had a sighting of him not five minutes ago, all the way across town, at a drive-by shooting. No way he made it over here that fast.”

“You underestimate Sumdood,” I inform him sadly, shaking my head.

Oh, little does he understand the nature of Evil. Am I alone able to sense his presence? Will I forever be cursed with the burden of thwarting Sumdood? Oh well, with great power comes great responsibility.

“Sumdood is all around us,” I educate the cop. “I have spent lonely years wandering the wilderness in my quest to stop him. It’s what I do. Picking up little old ladies who have fallen and can’t get up is just my cover.”

“Are you okay?” Officer Friendly asks, concerned. “You got a fever or something?”

“Listen to Ambulance Driver,” FP says solemnly. “We have seen things that would turn your hair white. Uh, that is, if you had any, I mean. Sumdood possesses powers that – “

“I got this, FP,” I say, interrupting my trusty sidekick. “Look, Officer Friendly. This is really beyond your level of experience and training. Sumdood has powers you can’t begin to fathom. He’s nearly immortal. Our only hope is to capture him when he takes physical form. You get the cuffs on him before he dissolves into smoke, I’ll bind him with the Sacred Three Inch Tape, anoint him with saline, and stab him in the heart with a sharpened caduceus made of rosewood. We’ll be heroes.”

“You guys have lost your fucking minds,” the cop replies in disgust. “That guy’s name is Tyrone Rockslinger. He’s lives over on Lee Street, and he’s been locked up in the parish jail for the past six months on possession with intent.

“You poor, deluded man,” I sigh tolerantly. “I realize this may sound unbelievable to you. It’s almost unbelievable to me too, and I’ve pursued Sumdood across the sands of time. Consider the fact that every description of Sumdood is different. Think of how Sumdood is often in two places at the same time. Think of how widely varied his modus operandi is. It’s obvious we’re dealing with a master criminal here, someone with superhuman powers.”

“We think he may be the third coming of the AntiChrist,” FP pronounces solemnly. “Only way to be sure is to examine his scalp.”

“You sure about this?” the cop asks dubiously. “He doesn’t seem all that dangerous-looking to me.”

“Looks are deceiving, believe me,” I warn him. “He is a shapeshifter, able to assume the guise of any being he touches. My guess is that the original Tyrone is stuffed in a trashcan somewhere.”

“And you say this Sumdood person is the one responsible for our complainant’s injuries?

“Oh, he’s responsible for a lot more than that, my friend,” FP says darkly. “He towed the iceberg into the shipping lanes, directly into the path of the Titanic. During the sacking of Jerusalem, he was directly respons -”

“He’s a bad dude, okay?” I interrupt, casting a warning glance at Farting Partner, “and this is as close as I’ve been since the Chicago Fire of 1871. We have to act now.”

“The Chicago Fire of 1871?” Officer Friendly asks skeptically. “Bullshit. Mrs. O’Leary’s cow started that fire, and – “

“There was a cow there, yes,” I explain urgently, my patience wearing thin. “There was a cow, and Sumdood was…well, he was trying to…see, he had the cow backed up to this stool and he was standing on it, and…well, I tried to stop him, and in the struggle a lantern got knocked over, okay? Satisfied?”

“But that was over 120 years ago,” Officer Friendly protested. “You don’t look much older than thirty-five!”

“I am far, far older than I appear,” I explain wearily, “but my soul cannot rest until Sumdood has been banished back into the depths. I am trapped on this plane until I have defeated my enemy.”

“Who are you?” the cop hissed, eyes bright with curiosity. And fear.

I have to level with this man. I need him.

“I am one of an ancient and secret order of paramedics,” I level with him. “Even the mention of our existence is forbidden. We live among you, and always we are watching. We have tracked Sumdood for milennia, seeking ever to thwart him in his quest.”

“And what quest is that?”

“The end of civilization as we know it,” I say flatly, meeting his gaze. “We managed to stop him when he sabotaged the bilges on the Ark. He released the first rat that started the Black Plague. He started the flu pandemic of 1918 when he sneezed into an all-you-can eat mutton bar in Madrid.”

“Ask anybody around here where they bought their methamphetamine, heroin or crack,” FP suggests. “What do they all say?”

“Sumdoo
d,” Officer Friendly muses thoughtfully.

“And who is the babydaddy of half the unwed teen mothers around here?” I ask.

“Sumdood.”

“Sumdood was the second gunman on the grassy knoll,” FP informs him.

“He kidnapped the Lindbergh baby, and let poor Bruno Hauptman take the fall for it. He has to be stopped.”

“And we’re pretty sure he was the source of the faulty intelligence that led us into Iraq,” FP furnishes. “We can’t let him get away.”

“We have to take this fucker down,” Officer Friendly says decisively. “He must be stopped.“

“Glad you saw it our way, Officer.”

“Hey you, Sum – I mean, Tyrone!” Officer Friendly bellows. “Get your ass over here!” FP and I take up flanking positions and don dark sunglasses, hands at the ready.

“Waaaaazzzzaaaap, Officer Friendly?” Sumdood brays as he sidles up. He casts a sidelong glance at me. I smile grimly, poised on the balls of my feet.

I know who you are, scumbag. And soon you’ll be mine.

“These EMTs here say you did this,” Officer Friendly says curtly, jerking his thumb at our gauze-helmeted patient. “As a matter of fact, they say you’re responsible for a lot more. I want some answers.”

“Whaa, me?” protests Sumdood, the picture of innocence. “I ain’t did nothin‘!” He fixes the crowd on the porch with a piercing stare. “Ain’t that right?”

“Uh huh,” gauze head agrees vacantly. “Musta been somebody else…”

“Ooooh, my bad!” chimes in his girlfriend with a glazed look in her eyes. “Gurlfriend wuz wrong.”

“See, Officer Friendly?” Sumdood grins triumphantly. “Just a case of mistaken identity. I can go now, right?”

“You can go now…” drools Officer Friendly as he stares into Sumdood’s eyes, slack jawed.

Sumdood throws us a mocking salute and does the pimp limp back into the crowd, fading into nothingness as FP and I stand there, mute in our rage. Sumdood is too strong for us to take on alone.

We were thisclose, people. Just a pair of handcuffs away from capturing the greatest threat to human health since AIDS or the Anopheles mosquito, and we missed our chance. But I’m still on the job, and I’ll never quit until I run Sumdood to ground.

But until then, Sumdood is still out there. And he’s only getting stronger.

I have a bleg.

Publisher and I have been tossing around a few ideas, basically on how to showcase my writing style to various publications and trade journals. He struck upon the idea of an advice column, one which allows me to dispense a little serious advice along with my particular brand of snark and humor.

So if any of you folks, particularly those in EMS, have any questions or advice regarding health care or EMS issues, feel free to drop me an e-mail. I’ll pick some of the better ones and post answers here. Let me know in the e-mail if you’d be willing to have your letter posted in the blog or not. You may choose a pseudonym, remain anonymous or use your real name – whatever floats your boat.

So lets hear some questions!

Those of you who have read all my archives have seen this before. It being graduation season with even a few proms still happening, I think it bears repeating. Impress upon your children the dangers of drinking to excess, be it passed out at a post-graduation party or wrapped in the wreckage of their graduation present. If I never run another call like this, it’ll be too soon.

It’s 3:17 am. This is our witching hour, when the weekend drunks have left the bars and headed home. Everyone else’s Circadian rhythms are at their lowest ebb, including mine. Around here, the cops catch the drunkest ones in town, as soon as they weave out of the parking lots. The ones we see are those who’ve slipped the net, or those driving home from Big City, 30 minutes away.

The strobes are hurting my eyes. I reach over and turn off the siren, earning a quizzical look from my partner. I snap at him, “Why do you have to run that fucking thing in the middle of nowhere on an empty road?” He says nothing, and I immediately feel like an ass. He’s just following company policy, and green enough to still worry about breaking the rules – even the ones that make no sense. But, he fears my disapproval even more, so he shuts his mouth and keeps driving.

Junior Partner is a good kid, just 25 going on 17. He still acts like a carefree high school senior, despite the fact that he’s got two kids. He’s been a First Responder for about eight months, just long enough to be excited rather than petrified about calls like this.

We’ve been slammed running transfers all day, and only got to bed just two hours ago. My eyes are sticky, and I’ve got a serious case of bed-head under my cap. My mouth feels like a cat shit in it. JP, on the other hand, looks fresh.

Fucking kid.

We’re heading to a “Signal 20-I,” which is cop-speak for a motor vehicle accident with injuries. They usually turn out to be total bullshit, or at the other end of the spectrum, road pizza. Not many fall in between.

At 3:17 am on the s-curves of Highway 35 South, they’re always bad news. There are enough little white crosses on that stretch of road to fill a small cemetery. JP is not yet experienced enough to dread calls like these. I know better. I’ve cared for my share of the names on those little crosses. JP slows down as he passes the Hooterville Volunteer Fire Department. The bay doors are open, a good sign. We don’t have direct radio contact with some of the volunteer First Responders, but I’m hoping the folks from Hooterville will be at the scene. Extra help never hurts.

As if reading my mind, the radio crackles, “Unit One, Dispatch. Be advised Hooterville First Responders are 10-97.”

Good.

JP slows even more as we round a curve, easing over the center line. A doe and two yearlings are standing in the ditch on my side.

“You see ‘em?”

“Yep. Big buck standing just in the trees behind them.”

“Well, be careful.”

The moon is full, and the deer will be night feeding along the road shoulders and in the pastures. At least once a year, a doe zigs where she should have zagged, and wipes out the front end of a rig. JP snaps the wheel to the right, just a little jerk to get my attention. It startles me a bit and I glare at him. He’s grinning at me. At least he’s not mad at me for snapping at him earlier.

“What, you got something against eating road kill?”

“No smartass, I just don’t like wiping out at eighty miles an hour.” He snorts, unable to envision a situation where his reflexes would not be equal to the task.

See what I mean about 25 going on 17?

JP isn’t a bad driver, just still sure of his own invincibility. I keep my mouth shut. I’ve bitched at him enough, and wrecking a rig might be one of the dues he has yet to pay. He slows down anyway and starts scanning the ditches. I suppress a grin and pretend not to notice. I realize that in the past ten minutes, we haven’t met a single car coming from the opposite direction – not a good sign. My grin fades.

The scene comes as a surprise as we top a hill just south of Robichard’s Grocery. The wreck was reported as several miles further south.

“Fuck me…” JP whispers.

My sentiments exactly.

On either shoulder, cars and pickup trucks are parked for a couple of hundred yards. Quite a few of the pickups have their emergency flashers on, red gumball lights on their dashes marking them as the firefighters’ personal vehicles. The last few motorists start to ease over when I hit the siren in brief bursts, and the sea parts.

There are remains of a compact car sitting crossways in the middle of the road, a mass of mangled metal, like ugly origami folded in the hands of a clumsy giant. It’s impossible to determine the make or model now. The front end is gone, the windshield a cloudy spider web of cracks.

A cluster of volunteer firefighters notices our arrival and beckon frantically. At least two more ignore us, leaning into the shattered windows on the driver’s side. I look at JP.

“Spine board and trauma bag. Let’s go.” He nods, throws the rig into park and bails out.

I am halfway to the wreck when more volunteer firefighters and good Samaritans get my attention. A Ford pickup is in the ditch on the opposite side of the road. A girl is sitting on the ground nearby, hugging her knees and sobbing, rocking back and forth.

All the commotion centers on a spot about ten feet past the truck. I stop, and JP nearly runs me over with the stretcher. I look back at him, hesitating. In the past, I’ve triaged the patients and decided which ones needed the most urgent care. JP has never had to manage a critical patient on his own. Looks like tonight there will be plenty for both of us, and the backup unit is just coming back into the parish, at least 25 minutes away.

Shit.

I grab him by the arm and shout over the snarling of the generator and Hurst tool the extrication crew has just fired up. “Look, holler for Unit Two, and have them start easing Unit Three this way. You take the pickup; I’ll take the car. If you get anything you can’t handle, come get me. Otherwise, just put the volunteers to work.” He bobs his head nervously and heads toward the pickup.

“Wait!” I call after him. I take the spine board and trauma bag off the stretcher. “Send somebody back to the rig for any equipment you need. I’ll take these.” He nods dumbly, and starts to turn away again. He looks scared.

“JP.” I say it softly, in my ‘Calm Voice’. His eyes shift back to me from the wreckage of the truck, and eventually lock with my own. “There’s nothing I can do for ‘em that you can’t. Just assess and package ‘em on boards, and I’ll do all the paramedic stuff on the way to the hospital. You’ve got plenty of help. You can do this.”

I turn away before he can reply. He’ll have to mana
ge on his own for the next few minutes, scared shitless or not.

The two firefighters leaning into the car are Frick and Frack, identical twins and EMTs from Hooterville. Where you see one, you will invariably see the other. In turnout gear, I can never tell them apart. One is reaching through the driver’s back window, maintaining spinal alignment while his brother is standing beside him, reaching through the front window applying a cervical collar.

The driver’s face is a wreck, blood and tangled blonde hair masking her features. I poke my head in between them, and Frick or Frack looks at me from behind the girl’s head, a grim smile on his face. “Wassup, AD?”

“You tell me, guys.”

Frick or Frack backs out of the car and gestures at the interior. I take his place and look in. In addition to the front-end damage, the passenger side of the car is caved in all the way to the center console, and looks to be folded over the girl’s right arm. I glance down at her legs, and they appear to have about four more joints than they should. About two inches of her right femur is protruding from her jeans. Her right ankle is folded under the accelerator pedal.

Her breathing is ragged and gurgling. Amazingly, the rear-view mirror is still attached to the shattered windshield. There is a brand new graduation tassel hanging from it. Everywhere there is a fine white dust from the airbags.

“We gotta get her out now, guys. Let’s see if we can pop this door first, and someone needs to get working on the passenger side to free her arm.”

I back away as the crew moves in with the Hurst tool. I get my laryngoscope and a tube from the airway kit. I hear the groan of tortured metal behind me as the spreaders pop the door open. I don’t really relish doing a seated intubation on this girl, but if we don’t get her out right this minute, that’s what is going to happen.

I can reach most of her now with the door out of the way, and as I maneuver in front of her, my arm brushes a trim piece folded over her arm. It moves easily and I tug at it. It comes away in my hand, and I notice that her arm is not entrapped at all. The metal is just crumpled over it, but there is nothing pinning her. Her ankle is broken, the foot folded back under and pinned beneath the accelerator. I move her lower leg and foot gently to the left and cringe as I feel the crepitus in her ankle. But her foot pops free, and I worm my way back out of the car and shout for the board. I lay my laryngoscope and tube on the remains of the hood, just forward of the windshield, and my scope promptly rolls down into a crevice somewhere in the engine compartment.

Lovely. Just fucking lovely.

One of the twins is wedging the end of the board against the seat while his brother holds spinal alignment. I grab the girl by her hips and torso and rotate her onto the board. It’s not pretty and we really need more people for the move, but there is simply no room. We manage to extricate her and strap her to the board.

I feel a hand on my shoulder and look up. It is JP. He has his patient packaged and on the stretcher. He looks a lot calmer now, sure of himself.

“Driver of the truck’s dead,” he says. “This one was ejected through the windshield. He’s unconscious, but he’s breathing. I’ll load him and send someone back with the stretcher.”

I grin at him and give him a thumbs-up as he moves away. Frick or Frack is digging around under the car, and comes up triumphantly with my laryngoscope. “Lose something, AD?” He grins at me and his brother joins in. “Boy, send a guy to Paramedic school, give him cool toys to play with, and we still have to go around picking up after him…”

I roll my eyes. “If you guys were actually any good, you would have found my tube as well. I’m not impressed.” They laugh some more as we load the patient onto the stretcher.

Our girl is not doing well. She has agonal breathing, and we hustle her toward the truck. I get another blade from the airway kit to replace the oil-smeared one I have, and intubate her lying right there on the stretcher at the back of the rig. There is more room and light there.

JP is behind me in the rig, setting up IVs and cutting the clothes from his patient. The tube goes in easily, with good breath sounds all around. Before I can place the tube holder, she bites down on the tube and curls her arms up to her chest in decorticate posturing.

Not good. I have to pry her mouth open to place the bite block between her teeth. As I secure the tube, I can hear a siren approaching, and Unit Two pulls up right behind us. I load our patient as Ernie Keebler walks up to the back of our rig.

“Need some help?”

“As usual, your timing is impeccable. You got here just in time to transport, but you managed to avoid all the hard work.” I love to give Ernie a hard time.

“Yeah, we timed it just right,” he grins, then turns serious. “How many patients do we have?”

“One DOA, two critical. If you’ll take the one JP has, I’ll take this one. We’re going to Big City.”

Over my left shoulder, and twelve minutes away, is Podunk General Hospital. It’s a good hospital, as small hospitals go, but they just don’t have the resources of Big City Regional Medical Center, twenty minutes away.

JP and I hand his patient out to Ernie. His wife, The Troll, has parked Unit Two’s stretcher at the back of our rig, and they slide the spine board onto their stretcher. As I hand the head of the board to Ernie, I notice that JP has written vital signs on the tape securing the patient’s head. The patient is moaning behind the non-rebreather mask. There are several deep lacerations on his forehead, and his upper lip is split all the way to his nose. His teeth are showing through the gap. I can smell the alcohol in his blood.

JP tosses Ernie a spiked bag of saline. “Here. Don’t say I never gave you anything.” One of the twins climbs into the back of the rig as JP slips out the side door.

“Found her purse in the car,” Frick or Frack says.

“Didn’t figure it was yours,” I grin. “It doesn’t match your belt or your shoes.” Frick or Frack replies with a grin and a one-finger salute.

“Need somebody to ride in with you?”
/>“I never turn down free help, man. Shut the doors and let’s go.” Frick or Frack takes over bagging while I get an IV. I slip in a 14-gauge and tape the line down as JP pulls away, forced to maneuver far onto the shoulder to get around the wrecked car.

I take her vitals, and don’t like the results. Her heart rate is only 62, and her BP low at 84/40. She stopped breathing on her own several minutes ago. Her chest and abdomen seem free of injuries, but her pelvis and legs feel like broken pottery. Both femurs and tibias are broken, as well as her right ankle, but I’m worried most about her head injury.

Aside from the brief episode of posturing when I inserted the tube, she’s been completely flaccid. Both her pupils are dilated and barely react to light. I’m still at least ten minutes away from the hospital, just passing into the outskirts of Big City, so I slip another large bore IV in her right arm and run in some Ringer’s solution. She’s had around 500 ml of saline, and I get Frick or Frack to get another set of vitals while I contact the ER.

Around here, all hospital contact is done via cellular phone, so I place the call while Frick or Frack struggles to hear a BP over the siren and engine noise. I recognize the nurse who answers the phone. My report is brief and to the point, nothing like the full patient report I was taught to deliver.

“Hey, Jeremy. This is AD with Podunk Ambulance. En-route to you with a female driver, frontal impact collision. Multiple lower extremity fractures, pelvis as well. Possible head injury. I’ve got her tubed, bilateral IVs and about 500 cc’s of fluid. GCS is 3, BP 80 palp, heart rate 60. We’re seven minutes out.”

I finish cutting her clothes off and assessing her. There’s not much in the way of outward injuries to treat, and splinting her legs at this point would be wasted effort. I feel the truck lurch, and suddenly we’re backing into the ambulance bay at Big City Regional. JP flings open the door and helps us unload. There’s a lot of shit to sort out – cardiac monitor, two IVs, oxygen tubing, and the shreds of her clothes hanging off the cot.

Jeremy meets us just inside the door. Just behind him is Doc Magoo. It’s late and she’s obviously tired. She looks haggard. She says nothing, just points to the trauma room.

As we move her over on the board, I give Doc the bullet: “Unrestrained driver, frontal impact. Airbag deployed, steering wheel deformed, windshield starred. Lots of dash intrusion. She was unconscious at the scene. Got her tubed, lines on the way, 500 cc’s of saline. Pelvis and lower extremities fractured, probably a head injury, too – her pupils are dilated and un-reactive.”

“Any posturing?” she asks, sidestepping to the left as the radiology tech maneuvers a portable x-ray machine into the room.

“She showed some decorticate posturing when I intubated her, but other than that, nothing.” I shrug my shoulders. It’s not an expression of indifference, just helplessness. Doc Magoo smiles tiredly as she turns back to the patient. She doesn’t waste her breath on words like “good job” or anything so trite – she doesn’t have to. I know if I had not done something to suit her, she’d have chewed my ass thoroughly.

I have a lot of respect for Doc Magoo. She’s a strong advocate for EMS, and always treats the crews with respect. On the other hand, she’s also quick to quietly, methodically tear off a strip of hide if you fuck up. She taught me the basics of acid-base balance in medic school – Magoo’s Acid-Base for Idiots.

I collect my paperwork and walk outside. As usual, my rig is a total mess. If trashing a patient compartment were an Olympic sport, I’d be a Gold Medalist. JP is busy cleaning up behind me, but it will be at least half an hour before we’re ready to go. I’ve managed to get blood on the cot, the grab rails on the ceiling, and on the underside of several cabinets – basically everywhere I put my hands. I help him make up the stretcher and carry the biohazard bag back inside for disposal.

Everyone is filing out of the trauma room – Doc Magoo, nurses, respiratory therapist, radiology tech, everybody. Our girl coded right after we got her there, and they’ve been working her for the past twenty minutes while we cleaned our rig. They’ve only just now called it. Just like that, a young girl is gone.

The ER staff never even knew her name. Come to think of it, neither did I. Her purse is still outside in the rig. I go back outside to retrieve it, and I find her wallet and driver’s license inside. She was eighteen years old, her birthday only a couple of weeks ago. Her name was Jennifer.

As I walk back inside with her purse, I pass a woman clutching a cell phone with a bewildered look on her face. I start to tell her that the ER waiting room entrance is around the corner, but she sees the purse in my hands and recognizes it. She looks a lot like her daughter.

She stops me and starts to ask me what, where, how her daughter is, but she can’t find the words. She just chokes back tears and looks at me pleadingly. I tell her that her daughter was badly injured, what I did for her, what the doctor and nurses did for her after we got to the hospital, but I am too much of a coward to tell her the rest. I want to be able to say something to this woman, something that will banish the horror of this night for her, but I can’t find the words either.

She asks anyway. “But, is she going to be okay?” My silence tells her enough, and she slowly collapses in on herself, sobbing but making no sounds.

“The doctor will be out to speak with you soon,” I tell her as I take her hand and lead her to a chair in the waiting room. It’s a lame response, and we both know I’m too much of a coward to tell her the news.

On the way out I tell the ER clerk that the girl’s mother is in the waiting room, and I climb into my rig to leave. JP is already behind the wheel, catnapping as he waits for me. The sun is coming up.

Some day, I’m going to get better at this. Some day I’ll know what to say.

…to make you cry, sometimes you get tagged with memes tooooooo…

Okay, so I took a little poetic license to the lyrics. Phlegm Fatale splattered me with a meme, and it goes something like this:

1. Go to the Billboard #1 Hits listings
2. Pick the year you turned 18
3. Get yourself nostalgic over the songs of the year
4. Pick 5 songs and write something about how these songs affected you
5. Pass it on to 5 more friends

I never really listened to a lot of pop hits from the year I turned eighteen. I was more of a fan of 70s rock, and the odd country song or two in the 80s. I turned eighteen in 1986, but I was only eighteen for a couple of months of that year, so I’m taking a page from Phlegm and Holly and using songs between October 1986 and October 1987.

If that violates the spirit of the meme, then screw it. I’m a rebel. That’s just how I roll, baby.

[secretly hoping there are chicks out there turned on by a bad boy Ambulance Driver]

1. Amanda, Boston. Call it a holdover from the 70s, but I have this thing for guitar ballads. Probably because they got me laid. The guitar licks are mediocre, and the lyrics are stale and sappy, but lucky for me back then, eighteen year old girls were no more discerning in their taste in music than their taste in eighteen year old boys. Case in point, ladies: How many of you used to swoon back in the day when you heard More Than Words, by Extreme?

Yeah, I thought so. Apparently, if you sing some version of “If you really loved me, you’d put out,” it works much better than actually coming out and saying it. And for those of us who couldn’t sing, we could always pop the Extreme cassette in…

2. The Way It Is, Bruce Hornsby and The Range. I still love that song to this day. In fact, I have all the songs from that album downloaded from I Tunes. I wore out two copies of the cassette. Even now, the lyrics ring true to me:

That’s just the way it is,
Some things’ll never change.
That’s just the way it is,
Oh, but don’t you believe them.

Melancholy and hope, all in the same song, and with that piano sound only Bruce Hornsby can do. It speaks to me.

3. Walk Like an Egyptian, The Bangles. Hated the song. Hell, hated the Bangles. But I wanted to run away and make little babies with Susanna Hoffs, so I watched their videos whenever I could. Susanna was hot. H-O-T. Muy caliente. Even now, whenever I think about Susanna Hoffs, I get all tingly in my naughty parts.

Ahem. Y’all may have to excuse me for a minute…

4. Lean On Me, Club Nouveau. I was too young for the original Bill Withers version, but I still dig the dance mix/reggae version Club Nouveau did. We be jammin, mon!

5. Still Haven’t Found What I’m Looking For, U2. Because it’s U2, fer Chrissake. Forget their politics, the whole “rockers with a message” thing. They made good music, with good lyrics and The Edge on guitar. Nuff said. And the Joshua Tree ranks high on my list of best albums ever.

Anybody else want to take this one up?

A reader asked my opinion on an article in the Washington Post regarding critical care without consent. The article (read it in its entirety) deals with the ethical dilemma of studies that deal with resuscitation science, ie how to obtain consent from a patient who is either in cardiac arrest or imminent danger of arresting.

First we need to discuss the concept of consent. Every treatment we provide requires some form of permission from the patient or a legal guardian. Likewise, a mentally competent patient can refuse any part of care at any point, even if that refusal may mean their death.

Now in most situations, this consent is verbally expressed from the patient to the caregiver. I’ll introduce myself to the patient, offer a handshake and ask if I may examine the patient. Most times they’ll take the proffered hand and tell me to go right ahead – hey, they already called 911 and asked me to come, right?

Now as a practical matter, any consent from that point is pretty much a given between the two parties. If there is anything I may try to do that John Q Patient doesn’t want, all he need do is say no, but it’s pretty much assumed they want the help I provide.

Now legally, the issue is somewhat thornier. To be legally defensible, a consent or refusal must be informed, ie the patient must understand the expected benefits, risks and complications of a proposed treatment. If they refuse treatment, they must also understand the risk of refusing.

For example, if I were to start an IV on a dehydrated little old lady, I’m supposed to say something along the lines of:

“Ma’am, judging by the orthostatic changes in your vital signs and clinical presentation, it is my belief that you are volume deficient and may benefit from the intravenous infusion of isotonic crystalloid solutions. This infusion will increase your intravascular fluid volume and also replace any depleted electrolytes lost through your vomiting and diarrhea. This should raise your blood pressure and may serve to relieve some of the cramps you are feeling, and the electrolyte replacement may also alleviate that myocardial irritability that is causing your heart to beat irregularly.

Now in the debit column, this intravenous infusion has a number of inherent risks, not the least of which is pain. You may experience some discomfort, and due to your depleted volume state and the condition of your veins, it may take a number of venipunctures to obtain a patent IV site. Other risks include venous irritation, thrombophlebitis or systemic infection, air embolus and even death. Plus I’m an evil bastard and don’t care for little needles, so this will probably hurt like a mofo, and we’ll have to roll you over and pull the sheets out of your ass afterwards.”

Or something along those lines.

But most often, that instead gets shortened to, “I need to start an IV on you, Ma’am. Give me your arm…big stick!…now, that wasn’t so bad, was it?”

In the event that the patient is a minor child, or is too incapacitated to express their consent, verbally or otherwise, we treat under the legal doctrine of implied consent, ie the assumption that if the patient were able to communicate, that they would want any standard medical treatment applied.

And herein lies the turd in the ethical punchbowl with regard to resuscitation studies. By their very nature, they are experimental. Not the accepted norm. Outside-the-box thinking.

A fine ethical line is tread here, lest we find ourselves venturing into Joseph Mengele territory. Typically, most IRBs (Institutional Review Boards, effectively research ethics committees) approach the problem in this way:

Before starting the research at each site, researchers complete a “community consultation” process. Local organizers try to notify the public about the study and gauge the reaction through public meetings, telephone surveys, Internet postings and advertisements, and through reports in local news media. Anyone who objects can get a special bracelet to alert medical workers that they refuse to participate.

Now, one bioethicist interviewed in the article took a contrary view to this approach:

“Suppose a 15-year-old child is in the back of a car that is in a terrible accident,” Annas said. “The EMTs arrive and say: ‘We are doing an experiment with two techniques. We think they are about equal. Is it okay if we flip a coin to see how we treat your son? Or would you rather we just give him the treatment we think is best?’ Unless you think all parents would have the EMTs flip a coin, consent here is necessary.”

He neglects to consider here the fact that such a scenario wouldn’t occur in a double-blinded study – neither the patient nor the medical providers know whether they’re getting the experimental drug. In the studies where blinding is impossible, it is paramount that the EMTs observe strict adherence to the protocol. To do otherwise would render the results invalid.

The Brain Trust and I were discussing this the other day, and the consensus was that the EMTs are not necessarily going to be using the treatment they think is best – they’re going to use the one that’s in the protocol. When the patient gets to the ER, the staff there is going to use a treatment that, while it may be the most popular and well established one today, is not necessarily well-grounded in science.

The general public, and to a large extent medical professionals fail to understand this:

Most of the crap we do is based on conjecture and animal studies, not science. Until the past few years, pretty much everything you read in an ACLS book was either well-compensated product placement or something that worked on pigs, rabbits and dogs.

Until we started looking at amiodarone in VF (ventricular fibrillation) arrest, not a single drug we used was proven to actually work on an adult human in cardiac arrest.

Not a single one.As it stands now, even amidoarone can only be proven to temporarily revive a corpse long enough to run up a whopping medical bill in the ICU, after which the patient dies anyway.

Patients enrolled in experimental resuscitation studies, at least the ones that involve cardiac arrest resuscitation, will still die 95% of the time using the currently accepted treatment methods.

If y'all will permit me to venture into medical punditry for a moment, I fail to see the ethical dilemma here. The only way we are going to advance resuscitation science is through randomized, controlled trials on cardiac arrest patients. The worst thing that can happen with the study drug is death. Death will occur 95% of the time with the standard treatment.

So instead of getting a "opt-out" bracelet like the ones typically offered, I think I'll get a universal, "opt-in" tee shirt that says:

I'm a gambler. Please give me the research drug, because I don't like the odds with the traditionally accepted ones.That answer your question, Marla?

When you partake in your Memorial Day barbecue today, try to remember a few things.

When the smoke from the grill blows into your eyes, try to imagine the terror of the young pilot as the smoke fills the cockpit of his F4 Wildcat, spiraling into the sea off Guadalcanal.

When you sample those pork ribs, remember the Iowa farm boy whose life blood stained the surf at Normandy.

When you eat a bite of potato salad, think of an Idaho preacher’s kid who died with a prayer on his lips, asking God to forgive him for the enemy soldiers’ lives he had taken.

When you welcome your niece’s new boyfriend to the table, remember the black kid from Mississippi who died right beside his white buddies in Vietnam, though he wasn’t even allowed to eat in the same restaurants back home.

When you scold your misbehaving grandchild, think of the little boy whose only knowledge of his father will come from stories told by family, because Daddy died on a dusty street in Fallujah while he was still in the womb.

When you fetch your wife another glass of tea, think of a young wife living in base housing at Fort Benning, as she hears the news that her husband died at Ia Drang.

When you invite Grandpa to say grace before the meal, think of young men cut down by a hail of fire from a Maxim at Belleau Wood.

When you reflect with pride on your daughter’s recent graduation, think of a young woman cartwheeling into the sea in her F14 Tomcat after a failed carrier landing.

When you look with distaste at the tattoos on her new boyfriend, think instead of the former gang kid from Detroit who found a way up and out of poverty in the Army, only to die from an IED blast in Baghdad. And remind yourself that what matters is how he treats your daughter, not the ink on his arms.

When you sit at the table, think of a Navy Captain, a husband and father, who died at his Pentagon desk on September 11. His death was no less honorable.

If you’re traveling today, think of the passengers of United Flight 93, for in a field outside Shanksville they became the first soldiers in our war on terror.

When your boys fight, as boys will do, remember the boys on both sides who died at Gettysburg.

If a loved one can’t make it to the gathering today, think of Mrs. Bixby and her five sons.

While your kids play in the pool this afternoon, think of other kids not much older, trapped below decks as the Arizona went under at Pearl Harbor.

When you take a shower tonight, think of young men reeking of machine oil and sweat, desperately trying, and failing, to surface their wounded submarine somewhere in the Pacific in 1943.

I tell you of these things not to spoil your appetite or your day, but to remind you that the things we enjoy in our lives are made all the sweeter when you consider what made them possible.

Remind yourself also that your sacrifice is infinitely easier. All you need do is sacrifice a moment of your time every few years to pull a lever. The way to honor a dead soldier is not simply to fly a flag on Memorial Day. Vote to preserve the freedoms they died defending.

The comments section is closed for this post. If you feel the need to say something, go instead here or here to tell a soldier how you appreciate their service, and how you pray for their safe return home.

Checked out the SiteMeter this morning, and WOW!

What happened to the usual Sunday drop-off?

I’d like to welcome any new readers who came here via Say Uncle and the Barking Moonbat Early Warning System.

It is nice to be noticed by the big boys. It is even more flattering when they say nice things.

I have read Uncle’s stuff fairly often through VFTP, but I must confess I’ve never visited Barking Moonbats until today.

Silly Ambulance Driver. That shall not happen again.

[note to self: Add Barking Moonbats to my RSS feeds]

Y’all welcome (the four of you who didn’t come through those sites today) both of them to the blogroll, and while I’m at it, Toys In the Attic and Pappa Delta Bravo.

Every single one of them are excellent reads.

“How long has he been down?” Pardner wants to know as he strips off his uniform. He sits on the bumper of the rig and hurriedly takes off his duty boots. Not bothering with buttons, he yanks his uniform shirt over his head, tee-shirt with it. He drops his duty belt, pager and radio still attached, on the grass behind the truck, almost an afterthought. It wouldn’t be the first pager he has taken into the water with him.

“¿Cuán largo ha estado él bajo el agua?” the game warden asks the kid. The little boy, wet and shivering under a rough woolen blanket, sniffles a response.

“Maybe fifteen minutes,” the game warden translates, defeat in his eyes. It’s understood that the game warden isn’t going in. He wants to, but he’s too old. If he obeyed his instincts, did what his manhood screamed for him to do, he’d have gone in.

And then we’d have two bodies to recover instead of one, and the game warden knows it. I know it, too. That’s why I’m not going in, either.

A few years ago, I would have. A few years ago, I did. But I have a wife now, and we want to have a baby some day. And I have learned that calls like these are body recoveries, not rescues. They’re not worth a second life.

But Pardner will not hear of it. He knows one thing: a six year old boy is under that murky, swirling water somewhere, and he’s not going to leave here without trying. He’s going in, and there’s not a damned thing the game warden or I can do to stop him.

I’m going to have to tell Rhonda when it happens. One day, I’m going to have to tell his wife, and his two kids, that Daddy died trying to save someone that couldn’t be saved, and that I didn’t do enough to stop him. That day might even be today.

“Down too long, man,” I try to tell him. “Don’t risk it.”

“Water’s cold,” he replies, scanning the steep bank. “We might get him back.” It’s not an argument or justification, even though it happens to be true. He’d be going in even if the water were ninety degrees.

Pardner gestures to the water and shouts to the kid, “Where?”

The little Hispanic boy, understanding the gesture, points to the water where he and his brother fell, a caved-in section whether the current had eroded the bank away. In this bend of Podunk River, the banks are steep, littered with fallen trees extending into the water, their root systems undermined by the high waters of early spring.

The trees hold fish, and that makes them popular with fishermen. Occasionally, they also hold dead little boys, like today.

Without hesitation, Pardner begins scrambling down the steep, crumbling bank towards the tree top at which the kid had pointed. Cursing, I sprint for the truck just as fast.

“Wait for the Goddamn rope, at least!” I scream at him in fear and frustration. I take a hundred-foot length of braided polymer rope and quickly tie it to the first thing I can find, which happens to be the little retainer ring mounted on the ambulance box that holds our rear doors open. I scramble as close to the bank as I dare, and peer down at the water, and see…

…nothing, just a swirl of water and tree limbs bobbing in the current, still heavy with new spring leaves.

Goddamn you Pardner, don’t you do this to me, you crazy bastard. Please let him come up. Come on Pardner, come up. COME UP.

I scan the water, looking for some sign of him, any sign. I begin kicking off my boots, and Pardner surfaces near the trunk of the partially submerged tree. He gasps and looks around wildly, trying to orient himself.

“Take the Goddamn rope!” I shout at him angrily, pelting him in the head with the coil. “Start a search pattern!”

Pardner nods and grabs the rope, leaving perhaps twenty more feet trailing away from him in the current.

We’re not trained for this, at least not formally, but we’ve done it before. Pardner will take the rope and start sweeping back and forth in a windshield-wiper pattern. Once he reaches the end of a sweep, he’ll move out another few feet on the rope and start the pattern again.

Only when we’ve done this in the past, we’ve done it with scuba gear and no sense of urgency, because we knew we were only recovering a body.

Pardner has completed one such sweep, each time staying down long enough to scare me witless, and finally he pops up in the far branches of the downed tree.

“Got him!” he gasps. He wraps the rope around one wrist, the kid tucked under one arm, and starts kicking for the bank. I haul on the rope for all I’m worth until Pardner arrives back at the bank, but the drop-off here is steep, and he can’t find his footing.

I see him struggling to hold on to the kid, so I scramble down the bank to help. I slide down the last four feet or so, and find myself in frigid water up to my calves. I lean back against the bank and plant my feet, hoping to keep myself from sliding further in, and Pardner treads water just an arm’s length away, one hand on the rope and the other holding the kid’s limp body.

The rope jerks in my hands, and I look up to see the game warden at the top of the bank, one foot on the downhill slope as far as he can stride, stretching his hand toward me.

“Take the kid up first,” Pardner coughs. He tries to hand the kid to me, but I can’t find a grip. Finally, I lunge and snag my fingers in the kid’s hair. Without hesitation, I drag him bodily out of the water by the hair of his head. This is not a time for niceties.

I manage to worm my way backwards up the crumbling bank until my feet are out of the water, with the kid clutched to my chest. I feel a hand grab hold of my shirt collar, and the game warden says, “I got you.”

I shake my head in response, unable to summon the breath to speak. The game warden lets go of my collar, reaches down and wraps the kid’s upper arm in a hairy paw, and yanks.

A few seconds later, he reappears at the top of the bank, one hand on the rope and another extended to me. I grab his hand and scramble up the bank, and together we haul Pardner out of the water.

Pardner stays there on the bank for a few seconds, on his hands and knees, head hanging. He’s still gasping for breath, and there’s a long ugly scratch, probably from a tree branch, running all the way from his belt line to his armpit.

The game warden and I scramble to get the drowned kid packaged on a spine board and loaded in the rig. We secure him to a board, strap him down and start doing CPR. The kid is limp and lifeless, the dusky blue of his lips in stark contrast to his normally dark complexion.

Pardner doesn’t rest for long, and presently he’s butting the game warden out of the way, handing me a laryngoscope, attaching defibrillator pads, hooking up an IV line, activating hot packs and the like. Getting the kid out of the water was only half the battle. Now we’re trying to revive him.

The rest of the story is anticlimactic. We coded the kid on the way to the hospital. I did some cool paramedic shit; intubated the little boy, pushed a few drugs, took turns with the game warden doing CPR. I even dropped a nasogastric tube and suctioned a lot of cold river water from the kid’s stomach. Then I re-filled his stomach with warmed saline in a desperate attempt at rewarming. When you’re working on a dead six-year-old and you’re twenty-five minutes from the little rural hospital, you’ll stretch the boundaries of futility.

I’d like to tell you that the kid lived, I really would. If you like happy endings with your heroic stories, you will be disappointed. There is no happy ending, save for the chance for a young mother to hold her son while he was still technically alive, and for an older
brother to believe he did the right thing in running for help.

And perhaps for an EMT to believe that he did something that mattered, no matter the end result.

See, Pardner was no foolhardy rookie. He well knew what could happen when he dove in that water, and this wasn’t the first time he had taken such a risk. He was long past the adrenaline junkie career stage. He did it because he couldn’t not do it, not and be the man his Daddy taught him to be.

But it wasn’t solely for this act, or a handful of others like it, that we nominated him for an award. It was for the more mundane, everyday sort of humanity that he practiced. It was those things I remembered that night in Nashville when he took his turn at the podium.

Things like holding a little old woman’s hand on the way to the hospital.

Things like bantering with a distraught family member as we sped the long miles between Podunk General Hospital and Big City Medical Center, spinning long yarns about his drunken Uncle Shorty and a mule interrupting the women’s Sunday School class.

Or maybe it was the mule who was drunk. I can’t remember, and I’ve yet to hear the entire story uninterrupted. But the family members hear it, and they rarely notice how feverishly I’m working on their Grandma in the back. Sometimes they even laugh.

It was for things like wrapping that young Mexican mother in his arms as she stood in the ER hallway, grieving the loss of her son. And when she tried to thank him, he couldn’t understand the language, but he grasped the meaning.

I was standing too far away to hear what he told her, but from his gestures, I could make an educated guess.

“I didn’t do it by myself, Ma’am. My partner there worked on him all the way to the hospital, and that game warden over there did all he could. I only wish we coulda done more.”

I barely even got my feet wet.

The only thing that keeps him consigned to the Reciprocal Blogroll is, oddly enough, his reticence in reciprocating a little linky love. I keep scanning his sidebar every day after reading his posts, hoping to find my name there on his blogroll.

Ambulancemen laughed and bantered as they fought to save the life of a heart-attack patient, putting a prawn on his chin and joking over whether it would be fried by the defibrilator, an employment tribunal was told this week.

Apparently, two UK medics got sacked for engaging in a little black humor at an inappropriate time and place. At least, it may have seemed inappropriate to the other medic who turned them in. Keep in mind that the only witnesses to their shenanigans were the other medics and the patient, who was in full cardiopulmonary arrest.

You regular readers know my feelings on this subject. As to whether these two medics were behaving inappropriately or the medic who turned them in needs the enormous stick pulled from his ass, I’ll reserve judgment for now. I don’t know all the facts.

Please note that I’m not advocating some tired, lame code of silence – “what happens on the rig stays on the rig” – either. Inappropriate behavior should be reported and punished. I’m just not sure what they did was all that inappropriate. In poor taste, maybe, but that’s the nature of humor of any stripe. Not everyone gets it.

I have a big mouth and a faulty internal censor. Profanity and I are well acquainted. My mouth has gotten me in trouble more than once, and I have been known to say some outrageous things.

But I am entering my fifteenth year in EMS, and in that time I have never gotten a complaint from a patient about my behavior.

Not a single one.

Six health care professionals over the years have seen fit to report me to my supervisors for some perceived slight or breach of etiquette, but in all those cases, the patient took no offense at my behavior.

And in retrospect, a few of those complaints were probably warranted. We’re not always on our best behavior, even when we try.

So the point is, I can commiserate with these UK medics. Not every joke scores a laugh, and some may unintentionally offend, and some times we say things we wish we could take back.

But what these medics did across the pond in the UK pales in comparison to this 100% Murkin discredit to EMS. It is to these *spit* “medics” that I address the following statement:

Get. Out. Of. My. Profession.

EMS neither wants you, nor needs you. Take your disrespectful, misogynistic, incompassionate, racist brethren with you. All your buddies who considered you to be “stand up guys” need to re-evaluate their own standards.

Tomorrow marks the end of EMS week in the United States. For the past six days, EMTs at agencies all across the country have been striving to portray our profession in a positive light. We have a seven-day window to raise some awareness of the critical issues EMS is facing. Seven days to make our case to Joe Sixpack, Suzy Soccermom, and Snidely Politician before we are once again relegated to the background, a health care afterthought until Joe, Suzy or Snidely happen to need an ambulance.

And for all our efforts to portray EMS in a positive light, we see crap like this far too often. It’s enough to make your head explode.

A few years back, I was at a major EMS convention in Nashville. During one evening’s entertainment, I caught a few snippets of a conversation at the table behind me. After a while, it became apparent that two of the EMTs behind us were party to a scandal that had recently rocked a major metropolitan Fire/EMS department. Drinking at station houses, strippers, sexual harassment of female department members…pretty sordid stuff, and it had made the rounds of the trade magazines, national news media and internet discussion lists.

And these two bozos were bragging of their part in it, and the fact that they had escaped punishment while their supervisors took most of the heat. To make matters worse, they had an appreciative audience.

Pardner and I listened to all of this we could, quietly finished our beers and left. It was either that, or lose our tempers and assault a table full of asshats. Their behavior had already tainted EMS in one city, and the last thing the profession needed was a news story of six medics involved in a bar brawl at the Wild Horse Saloon.

Plus, they were four fairly beefy firefighters. I’m not sure Pardner and I could have taken them.

The next day, I had the distinct pleasure of watching Pardner receive a national award for his accomplishments as an EMT. As I watched him there on the podium giving everyone else credit for his accomplishments – his Dad, his bosses, me, his patients – I was struck by the thought that this is what a credit to the profession looks like.

Definitely not buff. More like approaching middle age and getting lumpy.

Nor was he well dressed. If I hadn’t taken him at gunpoint to a haberdashery, he’d have been wearing Wranglers with a Copenhagen ring in the back pocket.

Not especially well-groomed either. His beard could have used a trim. His hair was a little long, but his Stetson hid it well.

He wasn’t all that well-spoken. He cleared his throat a lot. He stammered a bit. You could tell he was nervous.

The check he got with the award was going to be spent at Bass Pro Shops for Christmas presents for his kids. It had to, because the yearly salary he made still qualified his family for food stamps. He was poor.

But when he told a ballroom full of people, “I consider myself lucky to do what I do for a living. Most people never have the opportunity to find their purpose, but I have found what God put me on this earth to do,” you believed him.

Somehow, an apology for pushing over a homeless person just doesn’t ring as true, no matter how penitent-looking the transgressor, or how sharp his creases.

If I had known then…

…that EMS is more giving rides than saving lives, I’d have worked harder in college and become an emergency physician.

…that emergency physicians do a lot more rectal exams and boil lancing than chest tubes and intubations, I’d have decided to be an interventional cardiologist or a thoracic surgeon.

…that if I had not been too cocky and proud, I’d have asked for help, and a few people would still be alive. A mother would be seeing her first grandchildren about now. A brother would be seeing his younger siblings, the ones he practically raised, graduate from high school this week.

…that I’d one day find myself laying in a sandy ditch, trying desperately to secure a man’s airway by flashlight while he bubbled and frothed blood and broken teeth, that he’d be fogging fetid alcohol-laden breath into my face as I intubated him, I’d have chosen the less unpleasant task of fetching and toting equipment. And the man would be dead.

…that I’d one day have nightmares and no one to comfort me, that one day I’d come home to an empty house with no one to tell about my day, I’d have told my wife I loved her more often instead of assuming she knew.

…that it would take my skills five years to catch up to my ego, I’d have been humbler sooner. Less people would think of me as arrogant, and I’d have made more friends.

…that I’d one day grieve the death of a regular patient, I’d have never talked to them on those rides to the dialysis center and gotten to know them. I would have insulated myself from caring, and kept my distance. Then again, I wouldn’t have known the names of their children and grandchildren, how they felt when they saw their son graduate from college, or what it was like to live in your car during the Great Depression.

…that the skills I had learned as an EMT-Basic would serve my patients far better and more often than the things I learned in paramedic school, I’d have never gone to paramedic school. And maybe, just maybe, a handful of people would be dead instead of alive. It’s hard to tell.

…that one day I’d go through the pain I did after my separation, I’d have never gotten married in the first place. And I wouldn’t have this child dozing on the couch with her head in my lap.

…that one day I’d have to stretch my infant daughter’s limbs every night as she screamed in pain, that I’d drive 620 miles a week for a year to bring her back and forth to therapy, I’d have never tried to have a child in the first place.

Then again, I’d have never known how it felt to see her take her first steps. I’d have missed the joy in all those little victories. I wouldn’t know how calming it feels to hold her against my chest after a bad day.

…that some companies would value unquestioned obedience over good decision-making and critical thinking, I’d have never taken the job.

…that other companies, good but only mildly dysfunctional ones, don’t appreciate having their dysfunction constantly criticized, I’d have been more tactful and less blunt. Perhaps then they wouldn’t have fired my ass, and we could have fixed those little problems.

…that those same people could fire me, with my child struggling for life in the NICU and my wife on unpaid maternity leave, I’d have never bought their “we’re all family here” recruitment pitch. I’d have never gone to work for them, and chosen another company instead. God knows I would have been paid more.

I’d have also learned a lot less, laughed a lot less, and made less good friends. I’d have missed working with some of the best partners in the business, men and women whose equal I have found no where since.

And I also wouldn’t be vacillating between grief and spiteful gloating to see how that company has declined since I left. Triumph and tragedy in equal parts, there.

And that’s EMS in a nutshell. Triumph and tragedy in equal parts.

Lots of drudgery, interspersed with the occasional adrenaline jolt.

Numbing, mindless, repetitive work, with a piss-poor paycheck. And an occasional shining moment to make that all worthwhile.

Idealistic adulation from people who don’t know better, and undeserved scorn from people who should know better.

So when I look back through the retrospectroscope at the cocky little adrenaline junkie I was, and speculate that if I had known then what I know now…

I’d have never chosen EMS as a career.

And that would have been the biggest mistake of my life.

…alternatively titled: Short Attention Span Theatre.

Of course, I’m only sitting here and typing this today because I didn’t wear a seatbelt one morning. Had I been wearing it, I’d be in a wheelchair and/or have massive brain damage or be six feet under since the driver’s side roof crushed in on rollover impact.

Now, I’m torn on this issue. Normally I’d obsequiously agree with anything she says, cuz I lust after Babs like a fat kid eyes a pork chop. She’s smart, funny and gorgeous. You know, a lot like Tamara, only without so many weapons handy.

But her experience amounts to anecdote. Granted, an important anecdote, since it was her life spared, but still it flies in the face of the statistics. She’s an experienced ER nurse, I’m a medic. For every story like Babs’, I can recount a hundred others that support the use of seat belts. I’m sure she can as well. I won’t trot out the tired cliché that I’ve never cut the seat belt off a dead person, because I have. Plenty of times.

But the bottom line is, your chances of surviving an accident, be it a frontal impact, side impact or rollover, are exponentially greater if you stay in the vehicle. Get ejected, and likely as not, you’ll wind up an interesting maroon Rorschach blot on the pavement for others to contemplate on their daily commute.

And that is what seat belts do, folks. They keep you in the vehicle.

[Trivia tidbit: seat belts are not the primary restraint system in your vehicle. The windshields are. They do more than keep the bugs out of your teeth. If you have had yours replaced, make sure it was done correctly by a reputable auto glass shop, using a properly fitting gasket. Do not re-use the old one.]

As to the larger question of whether seat belts, and by extension motorcycle helmets, should be required by law, I’d say yes.

Put down your pitchforks, Libertarians and scooter enthusiasts. I personally subscribe to Matt G’s viewpoint, which he stated in his latest post: (emphasis mine)

First, because my libertarian thinking basically demands that I not give a damn about what you like to do in your bedroom, so long as it doesn’t interfere with my life. (Or the life of an unwilling party.)

Here’s my problem with the “personal choice” argument against mandatory seatbelt and helmet laws: Your choice does affect more than you. It affects your family and loved ones, but most importantly it affects me, the unwilling party.

Those fatality statistics and seat belt usage statistics have a bearing on my insurance rates. My premiums suck badly enough because of my driving habits. I’d rather not pay the price for yours.

And yes, I recognize the blatant hypocrisy in that statement. I also recognize that helmets restrict your vision and muffle your hearing and thus make you a less aware (and arguably less safe) motorcyclist, but they’re still a good thing. They’re not even that effective at protecting your noggin at highway speeds. But in support of the utility of helmets at lower speeds, I’ll offer two words: Gary Busey.

Name a decent Gary Busey movie since he whacked his head on the curb. Go ahead, I’ll wait.

[crickets chirping]

Okay, how about just naming anything coherent Gary has said since then?

The main reason I’m for seat belt laws and helmet laws is because of what happens if you don’t die in the accident.

Long term care runs in the millions of dollars over the life of the patient with a traumatic brain injury. Your automobile insurance policy won’t last through your ER visit and the first night of your ICU stay. Most health insurance policies will capitate after a couple of years.

After that, it’s tapping your savings, and when those are depleted, Medicaid. So the taxpayers and your family are picking up the tab for your personal choice.

And no, I won’t argue that such a system is even remotely fair. Marko does it better than I ever could. But that’s the system we have.

#3. When meme-tagged by your Goddess of Da Funny, you play along. Always. Even if you did a similar meme a couple of days ago. You just pull up your big boy drawers and get to work, because you never know how long it’ll be before she throws any more linky-love your way.